Tuesday, July 29, 2008

Bob Wachter’s Knol on the hospitalist model of care

Bob Wachter’s Knol is one of the better overviews on hospital medicine I’ve seen. The section on the history of hospital medicine is particularly good in that it explains the profound but underappreciated impact of Medicare’s Prospective Payment System, (PPS) enacted in 1983, on hospital economics. While not talked about much today the PPS was clearly one of the antecedents of the hospitalist movement. That fact dawned on me in a new way after I read Wachter’s Knol. What also dawned on me was an irony: I owe my hospitalist career in part to this manifestly unfair PPS, a system I’ve always loved to hate.

Wachter devotes considerable attention to the emerging subspecialty hospitalist movements (pediatric, surgical, neuro and obstetrical) thus establishing “hospitalology” in its various forms as subdivisions of parent specialties rather than a single specialty which cares for all inpatients regardless of illness. That’s as it should be, I think.

Apart from a few quibbles about how he handles the evidence regarding the efficiency of the model I agree with Wachter’s perspective and consider this piece a must read for anyone seeking a better understanding of hospital medicine.